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General NPI Number Information
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NPI Number | 1679059257
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Entity Type | Individual
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Provider Name | DARA SUON PHARM D
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Gender | Male
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 4555 N PERSHING AVE STE 7
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City | STOCKTON
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State | CA
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Zip | 95207-6739
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Country | US
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Telephone | 209-373-9629
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Fax | 209-473-7377
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Provider Business Mailing Address
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Address Line | 13260 ALTA MESA RD
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City | GALT
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State | CA
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Zip | 95632-8356
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Country | US
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Telephone | 209-822-6311
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Fax | 209-473-7377
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 47777
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License Number State | CA
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